On thin ‘ice’

Are we in the midst of an ice epidemic? Was the Prime Minister correct to say, when launching the National Ice Taskforce, that ice (methamphetamine) is our “worst drug problem” that it’s a “pernicious and evil” drug, and is “far more addictive than any other illicit drug”?

Or is this another cycle of drug alarm and groupthink? Recall, “reefer madness”, the “killer weed”, “the next crack cocaine”, “the meth mouth”, “the faces of meth” and “hashish assassins” ad infinitum.

On 8 April, Leigh Sales introduced the ABC 7.30 Report saying: “Revelations of ice use and suicide in the Australian Navy have shocked the Defence establishment and Australia’s political leaders.” This followed the previous night’s tragic report by Louise Milligan of nine suicides of young sailors at the West Australian naval base, HMAS Stirling.

No doubt, these perplexing and disturbing events demand reflection on the underlying causes of mental distress and suicide. But these important questions were conflated with “ice”, a spin-off from the PM’s announcement of the task force.

Next day, on Radio National’s AM program, Greens Senator Peter Whish-Wilson, himself a military veteran, was interviewed about the parliamentary inquiry he had instigated into mental health in the military community. Again “ice” was dragged to centre stage, not by the Senator but by Fran Kelly, the interviewer. Other media have been even more caught up in the “ice” frenzy.

But where do the amphetamines, methamphetamine, stand in relation to alcohol?

The population prevalence rate of methamphetamine use in 12 months is 2-3 per cent compared with the 83 per cent for alcohol.

Alcohol use disorders occur at 15-20 times the rate of methamphetamine disorders.

For every methamphetamine-related death there are 65 alcohol-related deaths; for every emergency presentation there are 30 alcohol-related presentations; for every ambulance emergency call-out there are 25 alcohol-related call-outs.

Many suicides are underpinned by illicit drug use, including methamphetamine, but alcohol intoxication and dependence is a far more potent factor in suicide worldwide. Of attempted suicides presenting to hospitals, 50 to 80 per cent had been drinking heavily or were intoxicated at the time and at post mortem alcohol is the drug most commonly found.

I am not disputing that amphetamine drugs are harmful. They can cause psychotic disturbances; about one in seven admissions for schizophrenia have a concurrent stimulant disorder. They cause anxiety, aggression and depression, on withdrawal, as well as affecting the cardiovascular system. But these are features too of alcohol intoxication and dependence as well as there being a veritable textbook of alcohol-caused mental and physical conditions and harm to others.

Policing and law enforcement are important especially to prevent the exploitation of vulnerable people. They can’t solve the “ice epidemic” despite the current wave of interdictions and arrests. Community-based solutions are needed – supports for families and children, educational and work opportunities for young people, early intervention and prevention, access to primary care interventions and to treatment and rehabilitation services; none of which are given priority compared with resources devoted to law enforcement.

Notwithstanding the need for action on illicit drugs, we cannot allow ourselves to be distracted from the larger and more pressing problem: alcohol and its associated harms. Not by the media eager to sensationalise every story and not by political leaders, driven to distract us in order to control the next news cycle.

This is an abridged version of a post which first appeared on John Menadue’s blog ‘Pearls and Irritations’.

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Ian Webster

Ian was the FARE Chair from 2001 to 2009. He is a consultant and Emeritus Professor of Public Health and Community Medicine of the University of New South Wales. He is Patron of the Alcohol and other Drugs Council of Australia, Chair of the Australian Suicide Prevention Advisory Council, NSW Expert Advisory Committee on Alcohol and Drugs, and Governing Council of The Ted Noffs Foundation.

This article has 7 comments

  1. sam Reply

    Thank you for this insightful piece! I have shared this amongst my networks. We can never shy away from the multitude of problems alcohol causes in this country.

    • Bernardino Reply

      Thank you, professor Webster. That is why Community Drug Action Team (CDAT) should live on!

  2. Jeni Reply

    Thank you! You have provided exactly what I needed today with this piece. The media have a lot to answer for; whipping the public into a frenzy regarding this drug ice.

    I was challenged recently when I stated that 2-3% of the population are/used ice. When readers responded that it was much greater numbers than that I explained that in almost any community we know so many people. Say we have 500 acquaintances: approx 1-15 of them (statistically) could be using ice. Then there are the 10-15/500 that each of those people know – or knows ‘of’. Then add that to the news reports and local word-of-mouth and suddenly 50% of the population are using ice.

    I shall be sharing this article more than once!

  3. Paul Reply

    The results from IDRS 2014 do show an increase in number of respondents reporting “drug most often injected in last 12 months” being crystal meth (Ice) from 15% in 2013 to 22% in 2014.
    Go here; https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/2014%20Drug%20Trends%20Conference%20Handout%20IDRS.pdf and scroll to table two to see this.

    Then scroll down to page 8, 9 and 10 where you will find tables that demonstrate no significant increase in the number of people reporting using methamphetamine, but a national increase in the number reporting using Ice, and a simultaneous decrease in the number reporting use of powder or base forms of the drug.
    There is also a significant increase nationally in reported number of “days used in last six months”.

    My interpretation, based on the available evidence;

    1) It appears there has been no significant increase in per-capita use of methamphetamine in Australia in the last few years. In fact, if you go back to 1998 you will find every jurisdiction except Tas had a higher number of people reporting meth use in the previous 12 months than we do now; (this site is about WA trends, but the first chart shows all states and territories- http://drugaware.com.au/Drug-Information/Amphetamines/Amphetamine-use-in-Western-Australia.aspx ).

    2) There are some regions (eg rural Victoria, The Pilbara and Kimberley regions in WA) in which there is some anecdotal evidence that methamphetamine appears to have become more available and affordable over the last three to four years. Unfortunately our data sources don’t provide any clear evidence of such localised trends, and the small populations involved mean that any such changes would not be observed in the national level data. However the impact in small communities may be much more noticeable.

    3) While there is no evidence of an “epidemic” (or any significant increase in the number of people using methamphetamine) there does appear to be an increasing trend in meth-related hospital presentations and people seeking treatment for methamphetamine use.

    4) There is evidence that a larger proportion of those people who use methamphetamine are using high purity crystalline meth (Ice), rather than powder or base, than was the case three or more years ago. There is also evidence that a larger proportion of people using meth are using it more regularly. If this is the case, higher average purity and more intensive patterns of use might explain increased numbers of hospitalisations for acute methamphetamine-related problems and increased numbers of people presenting for counselling or treatment re meth dependence. So, all this alarmist media hype may be a result of meth users becoming more “visible”, rather than increasing numbers of people using meth.

    There is an excellent discussion of the media and political hype and fear-mongering on this issue here;
    http://informahealthcare.com/doi/abs/10.3109/16066359.2015.1017571

  4. Paul Reply

    Further to the above, there are indications that the average purity of Ice, has increased significantly, (from an annual average of 21% in 2009, to 64% in 2013).
    The purity of traditionally lower-grade forms (powder and base) has also been increasing, (from 12% in 2009 to 37% in 2013).
    While the price per gram of crystal methamphetamine (Ice) has increased significantly, this is amply outweighed by even larger increases in average purity, making Ice more affordable.
    http://www.ncbi.nlm.nih.gov/pubmed/25220170
    This research shows a substantial decrease in the proportion of crystal methamphetamine seizures less than 10% pure, matched by an increase in those of 80-89% purity.

    The same research demonstrates that the majority of Ice seized in Victoria was of either extremely high purity (>70%) or of low purity (<20%) with few samples tested in between these extremes. It is very likely that unpredictable fluctuations in purity are responsible for some of the increase in meth-related hospital presentations.

    <<>>

    We have our politicians describing “Ice” as the “worst” drug, and as “mind eating” “personality destroying” and “life ending”. My fear is that this alarmist hyperbole will be used to justify more intrusive policing, more funding for border control, and harsher sentences for people found guilty of methamphetamine use, possession, or manufacture, without any attention to the social and economic factors that underlie the trends I have outlined (above). In fact we seem to have state and territory Governments who are determined to reduce funding to health, social welfare, and harm reduction + drug treatment services.

    Mass media prevention campaigns that demonise methamphetamine, only representing the worst outcomes, and announcements by authorities that exaggerate the harms of use, will not resonate with those people who use methamphetamine without experiencing such dramatic problems, (but who may be at serious risk of toxicity or of progressing to problematic and dependent use). Targeted education campaigns that provide credible information may reduce the incidence of acute problems and are also far more likely to encourage dependent users to seek treatment early.

    Dramatic scare campaigns in the mass-media are extremely unlikely to have any impact on uptake or per-capita use of the drug. In fact these sorts of approaches are likely to be actively counterproductive; stigmatising and marginalising methamphetamine users, increasing anxiety amongst users and the broader community, frightening family members and other possible psychosocial supports away from their loved ones when they most need help, and discouraging users from seeking assistance.

    Thanks Ian for addressing this issue.

    Regards,
    Paul.

  5. krystian Reply

    Agree to some extent with the article. However, my observations as a coal face worker in the field are not matched by ivory tower research which, as it usually does in this country, lags by about 5 years.

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